Performance Audit The Experiences and Perspectives of Washington Families who Adopted Children from Foster Care

Transcription

1 AUDITOR OF STATE WA S H I N G T O N NOV 11, 1889 Washington State Auditor s Office Integrity Respect Independence Troy Kelley Performance Audit The Experiences and Perspectives of Washington Families who Adopted Children from Foster Care February 10, 2014 Most parents who adopted children from foster care said in a survey that they do not need additional post-adoption services. However, some families cannot get all the services they require, especially for the children with the greatest needs. Many parents also had problems finding information about services in their communities. More than half of the families who negotiated their adoption support benefits in the past year gave poor to fair ratings to the state s negotiation process. We reviewed eight states that provide additional services for adoptive families and we provide information on their efforts to help Washington determine how to better meet the needs of families adopting from foster care. Audit Number:

2 Table of contents 3 Executive Summary 6 Background 8 Scope and methodology 10 Audit results 18 Recommendations 19 Agency response 22 Appendix A: Initiative Appendix B: Scope and methodology 25 Appendix C: Profiles of other states 33 Appendix D: Survey responses to select questions Americans with Disabilities In accordance with the Americans with Disabilities Act, this document will be made available in alternative formats. Please Communications@sao.wa.gov for more information. Adoption Services :: Table of Contents 2

3 Executive summary Providing help to families who adopted foster care children More than 9,000 Washington families care for children they have adopted from the foster care system. Many of these children previously suffered abuse and neglect, and need more assistance than other children. The Department of Social and Health Services Children s Administration manages the Adoption Support program to provide financial and other assistance to help these children and their families. The state and federal government split the cost of this program, mostly in payments that help families cover expenses. The state s program also provides pre-authorized payments for counseling for children and limited training opportunities for parents. Research shows that although most families do well, some families need more help. Researchers have suggested that states provide an array of additional post-adoption services that go beyond the financial support the federal government requires states to provide. While Washington previously attempted to expand its services for these families, it abandoned the effort due to budget constraints. To learn more about families service needs and their experiences negotiating their adoption support benefits, we surveyed a sample of parents in Washington. We focused on six services: individual counseling for children, family counseling, support groups, specialized child supervision, crisis intervention, and residential care. Most needs met, while some families need more services More than two-thirds of all of the families we surveyed did not need services beyond program benefits, or they could access the services they needed. However, about one-third of all families said that they could not access at least one service they needed or that the service they received was not beneficial. Needs and access varied by the service. For example, the program helps families access the most-needed service individual counseling for children. But the second most-needed service family counseling had the greatest unmet need compared to the other services. Children with the greatest needs face the biggest gaps in service The families most likely to need help had the most difficulty getting all the services they needed. Sixteen percent of the families we surveyed are raising children with diagnosed disabilities that severely affect their lives. Of these families, 57 percent reported unmet service needs. These families were more likely to need, but less likely to get, the services we asked about in the survey. Post Adoption Services Survey The Experiences & Perspectives of Washington Families Most needs met, but some families can t get needed services All survey respondents for all services Need met 27% No services needed 44% Unmet need 29% Source: State Auditor s Office anlaysis of survey results. Biggest gaps exist for families with the greatest needs Represents survey responses from the 16% of the families with the greatest need No services needed 6% Need met 38% Unmet need 57% Source: State Auditor s Office anlaysis of survey results. Adoption Services :: Executive Summary 3

4 Families need information about services Accessing information about services is another significant challenge. Almost half of all the parents surveyed said they had difficulty finding information about how best to care for their child. Parents also lacked information on how to access crisis intervention and residential care services. Again, the families with the greatest needs were more likely to say they could not find information. One parent said, It would be really great if information on all services available for adopted children was on a website and readily available. Some parents reported challenges negotiating their adoption support benefits Twelve percent of the parents we surveyed negotiated their support benefits in the past year. Of these parents, more than half gave poor or fair ratings when asked whether program staff gave adequate consideration of their children s needs or the families circumstances. These payments are not one rate fits all. Federal law mandates that the state give adequate consideration of the child s special needs and the family s circumstances when determining adoption support benefits. Their frustration is due in part to the lack of guidelines for the program that resulted in different regional practices for negotiating benefits. In order to improve the program, the Legislature acted in 2012 to centralize the program and create consistent practices statewide. The program centralized adoption support staff in July 2013 and is developing guidelines to improve consistency. One parent said, Thank you for adoption support, without it we could not have done this! One parent said, The process is very nebulous, there were no clear guidelines. Other states provide resources and services that Washington families seek Washington families are not alone in needing services to help their children adopted from foster care. We wanted to know what other states are doing to help families who have adopted from foster care. We spoke to national experts to identify states with leading practices, and we identified states with populations similar to Washington. Using these two criteria, we selected eight states to examine in more detail. We identified some common practices: All eight provide services designed for the small number of families caring for children with significant needs. All eight provide information and referral services. All eight contract with nonprofit organizations to provide some of their services. Seven use federal money to help pay for the programs. The eight states we contacted are Alabama, Georgia, Illinois, Indiana, Massachusetts, North Carolina, Oregon and Tennessee. Adoption Services :: Executive Summary 4

5 Recommendations We recommend the Department of Social and Health Services Children s Administration: 1. Develop a plan for enhancing post-adoption services for families adopting foster children using the parent survey results and information from other states. The plan should include strategies for addressing the largest service gaps identified in our report, including: Services for children whose disabilities significantly affect their lives Information on available services Submit the plan and associated resource needs to the Governor and the Legislature for consideration by January 1, Reach out to parents one year after DSHS finishes centralizing the program to determine whether their satisfaction with the unit s performance and its consistency has improved and report the results of its analysis to the Governor and the Legislature after the outreach is completed. Adoption Services :: Executive Summary 5

6 Background Some 1,293 children in Washington s foster care system were adopted into permanent homes in fiscal year Many have suffered abuse and neglect before being placed in foster care. Adoption provides some of these children with a stable family for the first time. The federal government and the state want these new permanent families to succeed. Together they split funding for the Adoption Support program, which provides benefits to families to help overcome the financial barriers they face adopting children from foster care. The program requires states to provide monthly benefits, reimbursement for one-time costs, and Medicaid health coverage for the adopted child. In 2012, Washington provided about $94 million in benefits to more than 9,000 families who have adopted about 14,000 children from the state s foster care system. The majority of spending went to monthly financial assistance, and most Washington parents receive between $300 and $600 per month. Like many other government services, this program has been affected by budget cuts. Due to the state budget crisis, the Legislature acted in 2011 and 2012 to limit growth of the program s costs by reducing the maximum amount of financial benefits that new families can receive. The Department of Social and Health Services Children s Administration manages the Adoption Support program. A state adoption support consultant meets with the family before the adoption is finalized to explain the program and negotiate the benefit amount based on the child s needs and the family s circumstances. Some families need more help Although research shows that most adoptive families typically do well, some families need more help. Children adopted from foster care are more likely to have emotional and behavioral problems than other children. They have higher rates of physical health problems and many are at risk of or have been diagnosed with a disability. Many of these children struggle in school: 58 percent of children whose families receive adoption support benefits in the state are in special education programs compared to 13 percent of all children in public schools. Studies have found that some parents have trouble finding the services they need, which can cause problems for parents and children already struggling to overcome problems stemming from abuse and neglect. Researchers have identified an array of additional post-adoption services that are beneficial to adoptive families and suggest that states provide these services. Six services they recommend are: individual counseling, family counseling, support groups, specialized child supervision, crisis intervention, and residential care. Beyond the federally mandated benefits, Washington s Adoption Support program currently offers two post-adoption services: pre-authorized payments for individual counseling for children and training opportunities for parents. Washington does not provide any other post-adoption services, and families must find any services they need from other government agencies, nonprofit organizations, or private providers. Adoption Services :: Background 6

7 In 2005, the state began an initiative to expand services for these families (and guardianship and kinship families), but discontinued the program a few years later due to budget cuts. In 2012, the Severe Abuse of Adopted Children Work Group recommended that Washington develop a continuum of support services for adoptive families. Facts about families who adopted children from foster care in Washington More than 9,000 families* About 14,000 adopted children** Average age of child: 12 Average age of parents: 51 86% of families have adopted 1 to 2 children 86% of parents are Caucasian 30% of adoptions were interracial Median household income: $57,580 29% were kinship adoptions in which a relative adopts the child 22% are single parent households About half have a college degree Source: Survey results. * Source: Fiscal year 2012 Social Services Payment system data. ** Source: Fiscal year 2012 Washington State Caseload Forecast Council. Adoption Services :: Background 7

8 Scope and methodology We designed this performance audit to answer these three questions: 1. To what extent are the service needs of families who adopted from Washington s foster care system being met? 2. What are parents experiences working with Department of Social and Health Services Children s Administration to negotiate their benefits? 3. What can we learn from other states programs that can help improve services for families in Washington? We used three different approaches to address the audit objectives: Review of national research: We reviewed numerous reports and studies that are made available through the Child Welfare Information Gateway, Casey Family Programs, and the National Resource Center for Adoption. We used the reports and studies to identify the benefits of post-adoption services and to inform which services to ask families about in the survey. Survey of adoptive parents in Washington: We surveyed a scientific sample of 1,686 parents who had adopted children from foster care in Washington to find out more about their service needs and experiences with the adoption support negotiation process. We received 754 replies; not all parents answered all questions. The sampling allows us to project the results onto the entire population of Washington families who have participated in the Adoption Support program. It is important to remember that the survey results are self reported and, as such, cannot be verified because there are no external sources of data available for comparison. We asked if the family needed a service and, if so, were they able to access the service. We asked if it was beneficial and what kinds of challenges the family faced trying to receive the service, including whether they could find information on the availability of services. (See Appendix D to see how families answered questions about their experiences and challenges accessing these services.) Other state case studies: To find out what other states are doing to help families who have adopted from foster care, we spoke to national experts to identify states with leading practices and identified states with populations similar to Washington. Using these two criteria, we selected eight states to examine in more detail. (Alabama, Georgia, Illinois, Indiana, Massachusetts, North Carolina, Oregon, and Tennessee). We wanted to learn more about what they offer and how they structure and operate their programs. Appendix A describes the provisions of Initiative 900 and how the audit addressed those provisions. Appendix B describes the audit methodology in more detail. We conducted this audit under the authority of state law (RCW ), approved as Initiative 900 by Washington voters in 2005, and in accordance with generally accepted government auditing standards, prescribed by U.S. Government Accountability Office. Those standards require that we plan and obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives. Adoption Services :: Scope and methodology 8

9 Next steps Our performance audits of state programs and services are reviewed by the Joint Legislative Audit Review Committee (JLARC) and by other legislative committees whose members wish to consider findings and recommendations on specific topics. Representatives of the State Auditor s Office will review this audit with JLARC s Initiative 900 Subcommittee in Olympia. The public will have the opportunity to comment at this hearing. Please check the JLARC website for the exact date, time, and location ( The State Auditor s Office conducts periodic follow-up evaluations to assess the status of recommendations and may conduct follow-up audits at its discretion. Adoption Services :: Scope and methodology 9

10 Audit results Answers in brief Question 1: To what extent are the service needs of families who adopted from Washington s foster care system being met? Answer: Most service needs are being met. However some families cannot get all the services they require, especially for the children with the greatest needs. Many parents also had problems finding information about services in their communities. Question 2: What are parents experiences working with Children s Administration to negotiate their benefits? Answer: Twelve percent of the parents we surveyed negotiated benefits in the past year. Of those parents, more than half gave poor to fair ratings regarding negotiating adoption support benefits. This is due in part to a lack of best practice guidelines for the program. Question 3: What can we learn from other states programs that can help improve services for families in Washington? Answer: Eight states we reviewed provide resources and services that Washington families seek. The Children s Administration may be able to benefit by learning from other states experiences and practices. Question 1: To what extent are the service needs of parents who adopted from Washington s foster care system being met? Most families needs are met, but some families cannot access services they need More than two-thirds (71 percent) of all parents who responded to the survey either did not need any services or could get the beneficial services they wanted. Nearly half (44 percent) of all parents said they did not need services beyond the financial support the program provided. Some parents told us that the adoption support benefits help them provide better care to their children and that they are grateful for the support. Another 27 percent were able to access the services they needed and said the services benefited their child. The program is helping provide the most-needed service individual counseling for the child. We focused on the families who said they needed services. An unmet need occurred when a family could not access or did not benefit from a service they needed. Needs were deemed met when a family could access and benefited from a needed service. The survey results show that about one-third (29 percent) of all families could not access at least one service they needed or said the service they received was not beneficial. For example, the second most-needed service, family counseling, had the greatest unmet need compared to the other services. Furthermore, the gap widens considerably when we looked at the difference in responses between the families overall and the families whose children have the greatest needs, as we discuss on pages Exhibit 1 - Most needs met, but some families can t get needed services All survey respondents for all services Need met 27% No services needed 44% Unmet need 29% Source: State Auditor s Office anlaysis of survey results. Adoption Services :: Audit results 10

11 Needs and access vary by service The extent of the unmet needs varies by service, in part because some services are easier to receive. The Adoption Support program directly helps families access individual counseling for children, while families seek other services elsewhere, including from state or local government agencies, non-profit organizations, schools, and private providers. Not all parents answered all questions but enough did respond to allow us to project our results to the overall population of adoptive parents. See Appendix D for number of respondents service by service. Individual counseling Most-needed and easiest to access service Individual counseling refers to mental health treatment focused on a child s needs, behaviors and interaction with family. Counseling can help improve children s ability to learn, develop friendships, and engage with their family. Slightly less than half of all parents (45 percent) said their children needed individual counseling. Most of these families were able to access it and said the service benefited their child. The counseling benefits provided through the Adoption Support program help to increase access to the service. Counseling benefits are available for families who cannot pay for the service through private insurance or Medicaid and about one third of the parents used these program benefits to help pay for these services. Some parents told us that they could not have afforded this service without them. However, 11 percent of all families were not able to access individual counseling or said the service was not beneficial. Those who said they needed the service said the biggest challenges were finding a provider in their area and cost. Some parents who said the service was not beneficial said the counselor was unable to help their child due to the extent of the child s needs. Family counseling Second most-needed service and the greatest unmet need Family counseling treats the entire family as a unit, helping them work together to improve communications, solve family problems, and create a better functioning home environment. Family counseling is not available through the Adoption Support program, so families pay for it out of their own funds or through private insurance or Medicaid. About one-third (34 percent) of all parents said they needed family counseling. Just over half were able to access beneficial services. Some parents described their counselors as caring and supportive, and they considered the support essential. Some families met with the same counselors who provided individual counseling for their children. However, the other half had trouble accessing this service, making it the greatest unmet need compared to other services. Expense and the lack of qualified family therapists were the biggest challenges. Some parents told us they had trouble finding a counselor trained to help children deal with issues arising from abuse or neglect. Exhibit 2 - Individual Counseling Need met 34% No services needed 55% Unmet need 11% Source: State Auditor s Office anlaysis of survey results. One parent said, the therapist has given our family a new lease on life. Exhibit 3 - Family Counseling Need met 19% No services needed 66% Unmet need 15% Source: State Auditor s Office anlaysis of survey results. One parent said, we really could have used more support to deal with issues that we didn t understand. Adoption Services :: Audit results 11

12 Support groups Small need; access to beneficial services was mixed Support groups allow adoptive families to offer each other emotional help, advice and encouragement. Benefits can include feeling more connected to the community, more knowledgeable about adoption related issues, and more committed to working through problems. A small number of all parents said they wanted to join a support group (13 percent). About half of these parents were able to find one. Some parents sought out other parents with similar experiences and created their own group or found support groups online. A few parents noted these groups were helpful places to get information, and participating reminded them they are not alone. However, the other half reported they could not find a group to join. Some said they did not know how to find one, some said the meeting times were inconvenient, while others could not find a compatible group. Specialized supervision Small need; most who needed could not access Specialized supervision refers to child care or supervision that takes into consideration a child s special physical, mental, developmental, cognitive and emotional needs. When children have needs that cannot be served by traditional after-school programs or conventional day-care centers, some level of specialized supervision may be needed. The types of specialized supervision these families needed most were in-home care, summertime activities, and after-school activities. Some parents told us their needs were served through their child s school or through the Department of Social and Health Services Developmental Disabilities program. A small percentage of all families needed this service (15 percent). More than half of these were not able to access it or benefit from it. Most often, parents who needed the service said specialized supervision was costly and they had difficulty finding a qualified provider. Some parents said it was hard to find providers who care for children with behavior problems. Crisis intervention Few needed this service and most had access Crisis intervention refers to emergency and temporary care given to individuals to address unusual stress in their lives that renders them unable to function as they normally would. Crisis intervention services in the state are available through a number of sources including local crisis hotlines, 911, the Washington Recovery Helpline, and the Regional Support Networks. Few families (8 percent) needed this service; and most who needed it accessed it through the resources described above. Other parents said they had challenges knowing whom to contact and finding a qualified provider. Exhibit 4 - Support Groups No services needed 87% Need met 6% Unmet 7% need Source: State Auditor s Office anlaysis of survey results. Exhibit 5 - Specialized Supervision Need met 6% No services needed 85% 9% Unmet need Source: State Auditor s Office anlaysis of survey results. Exhibit 6 - Crisis Intervention Need met 6% Unmet need 2% No services needed 92% Source: State Auditor s Office anlaysis of survey results. Adoption Services :: Audit results 12

13 Residential care Few needed this service but hardest to access Residential care provides treatment services for children with mental illness or severe emotional problems. Residential care settings in the state include group care facilities, inpatient treatment at a hospital or facility, and behavior modification programs. The need for this service is very small. Experts say that the best place for children is at home with their families, but there are times when children need to be placed in more restrictive environments for their own safety or for the safety of others. Few parents (5 percent) said their children need some type of residential care. These parents are worried their children may hurt themselves or someone else in the family, or have started to use drugs or alcohol, and no other intervention has worked. These parents noted it is hard to find information about available residential care options. They feel that good options are hard to find or expensive. Children with greatest needs face the biggest gaps in service About 16 percent of all parents surveyed are raising children with a diagnosed disability that severely affects the children s lives. They reported the largest gap between their needs and the services they received. More than half (57 percent) said their children did not receive or benefit from at least one service they needed (of the six services listed in the survey), more than twice the rate of the rest of the families. These families typically needed three services, compared to an average of one service for the rest of the families. These families were also more likely to need all six of the services we asked about in the survey. However, as Exhibit 9 shows, families with the greatest need were less likely to get or benefit from most of these services. The only service with no significant difference in access is crisis intervention. Exhibit 9 - Families facing greatest challenges have most unmet needs Percentage of families not receiving or benefiting from services Exhibit 7 - Residential Care No No services services needed needed 92% 95% Need met 1% Unmet need 4% Source: State Auditor s Office anlaysis of survey results. Exhibit 8 - Biggest gaps exist for families with the greatest needs Represents survey responses from the 16% of the families with the greatest need No services needed 6% Need met 38% Unmet need 57% Source: State Auditor s Office anlaysis of survey results. Service 16% Families with greatest needs 84% Other families At least one unmet need 57% 23% Specialized supervision 30% 5% Family counseling 29% 13% Individual counseling 21% 9% Support groups 14% 6% Residential care 13% 2% Crisis intervention 3% 2% Source: State Auditor s Office analysis of survey results. Adoption Services :: Audit results 13

14 Of these services, only individual counseling is paid for by Children s Administration through the Adoption Support program. Parents must stitch together the rest through a patchwork of private providers, nonprofit organizations, or other government agencies. The stakes can be high for these families. Several parents who have been unable to access services said they are struggling to raise their children, and some of them feel unsafe in their homes and are concerned that their children are at risk of harming themselves or others. One parent described trying to help a child overcome a pattern of stealing, while another parent described trying to help a child who had considered suicide. Children with the greatest needs have some unique characteristics compared to other children adopted from foster care. They tend to have mental, cognitive, and emotional disabilities at higher rates than their peers. They are usually older; an average of two years older than the other children in our study. Older children can have a higher risk for behavioral problems and be more difficult to supervise. Parents have difficulty finding helpful information Almost half of all parents surveyed said they had difficulty finding information on how to best care for their child. Parents also lacked information on how to access crisis intervention and residential care services. Some parents told us that they would like to have a list of Medicaid providers and be able to find counselors who know how to help victims of abuse and neglect. Surveys done in other states consistently identify a need for information about the resources available to parents. Easy access to an appropriate resource can prevent escalation of problems that lead to crisis. All eight states we included in the case studies (See Question 3 on page 16) offer some type of formal information and referral services. Although the Adoption Support program consultants try to help parents who ask about services in their area when time permits, the program does not have a formal information and referral component like these other states. Families whose children s lives are severely affected by their disability (16 percent of all families) had a particularly hard time finding information. Some of these parents said they needed assistance finding counselors who could help their children work through issues caused by prior abuse and neglect. They also wanted information on additional services that might be available for their children, both now and after they are older and no longer eligible for the Adoption Support Program. In addition, parents noted it is very hard to find information about how to access residential care and any type of respite care or specialized supervision for their children. One parent said, I was not prepared for how the behavior of my child could turn my life upside down. One parent said, It would be really great if information on all services available for adopted children was on a website and readily available. Adoption Services :: Audit results 14

15 Question 2: What are parents experiences working with Children s Administration to negotiate their benefits? Some parents reported issues negotiating their adoption support benefits Twelve percent of parents said they negotiated their adoption support benefits during the past year. They reported the following: More than half gave poor or fair ratings when asked whether program staff gave adequate consideration of their child s needs or the family s circumstances. Forty percent gave poor or fair ratings for the explanations they received about the benefits determination process. Adoption Support is not a flat, one rate fits all program. Federal law mandates that the state provide adequate consideration of the child s special needs and the family s circumstances. In addition, state law requires that the program consistently assess children s special needs and family circumstances. Program staff negotiates benefit levels with parents. The negotiations occur before the adoption, and again when the family feels its circumstances or the child s needs have changed. Program management said negotiating with parents is the primary role of the state s adoption support consultants. According to program management, the parents frustration may be due in part to different practices for determining benefit levels. Until recently, adoption support consultants reported to regional managers. Under this decentralized structure, the program lacked uniform guidelines for staff to follow when negotiating benefits. Program management noted staff used different practices for determining benefit levels due to the lack of uniform guidelines. In an attempt to improve the process, the Legislature in 2012 required the program to establish a central unit of adoption support consultants to help ensure consistent negotiations of adoption support agreements. By July 2013, the Adoption Support program had reassigned all 11 adoption support consultants from regional managers to one program manager in the central office. As the agency completes the transition to a central unit of adoption support consultants, management said they are currently developing consistent negotiation processes and practices. If the agency completes this process successfully, it should improve the consistency and quality of the negotiation process and experience for families. Once the process is complete, it will be important for the agency to evaluate whether parents satisfaction level has increased. Adoption Services :: Audit results 15

16 Question 3: What can we learn from other states programs that can help improve services for families in Washington? Other states provide resources and services that Washington families seek We wanted to know what other states are doing to help families who have adopted from foster care beyond the federally mandated benefits provided through the Adoption Support program. We spoke to national experts to identify states with leading practices and identified states with populations similar to Washington. Using these two criteria, we selected eight states to examine in more detail. The eight states shared how they operate their programs, what services they provide, and how much their programs cost. We identified some common practices: All provide services designed for the small number of families caring for children with significant needs. All provide information and referral services. All contract with nonprofit organizations to provide some services. Seven use federal money to help pay for the programs. The budgets and size of these programs varied widely across the eight states. The programs cost from $336,000 to $9.9 million a year and served from 200 to more than 2,000 families. Washington does not offer similar post-adoption services. In 2005, Washington used federal Adoption Incentive funds to begin Post Permanency Resource Centers in several regional and tribal areas in the state to provide services to adoptive, guardianship, and kinship families. Services included information and referral, support groups, and other mentoring and training opportunities. The state stopped providing those services a few years later due to budget cuts. Serving families with significant needs All eight states developed post-adoption service programs specifically for families caring for children with significant needs. The states created programs that typically offer a coordinated approach to providing services for these families. For example, Massachusetts dispatches regional response teams consisting of two case workers and a parent liaison to help families experiencing challenging situations. Tennessee provides home visits weekly or even twice a week and helps families navigate educational, mental health, and medical provider systems. Other states provide consultation services, in-home parent coaching, and teams of professionals working together to meet families needs. Providing information and connecting families with resources All eight states offer some formal information and referral services. In many states, parents call information lines for help. One is staffed 24/7, while others are open during weekday business hours. In Georgia, families call an information line and within 24 hours a staff member or experienced parent calls the family and answers their questions. In Illinois, clinicians who staff the information line are required to hold a master s degree. We selected eight states for evaluating leading practices: Alabama Georgia Illinois Indiana Massachusetts North Carolina Oregon Tennessee See Appendix C for profiles of each state. Adoption Services :: Audit results 16

17 Other states maintain provider contact lists and libraries. Two states, Oregon and North Carolina, maintain online databases of counselors, therapists and support services. To ensure families can receive care, some states like Georgia and North Carolina keep track of the providers who accept Medicaid. Five of the eight states also maintain office or online libraries of books, videos and other helpful resources. Contracting with nonprofit organizations Every state we reviewed contracts with one or more nonprofit organizations to provide some or all of its post-adoption services. Four states contract with one nonprofit organization to operate a resource and service center, while the other four states use multiple organizations. The states said they use nonprofit organizations because families are more likely to contact a nonprofit group than the state child welfare agency and nonprofit organizations often develop relationships with families during the adoption process. Most of these states use some federal funds for post-adoption services Seven of the eight states use federal funding to help pay for their services and resources either Adoption Incentive Awards or Social Security Act Title IV-B funding, or a combination of the two. The applicable section of Title IV-B, Promoting Safe and Stable Families, requires states to contribute a 25 percent match. One, Massachusetts, uses all state funds. Innovative approaches states use Indiana, Illinois and North Carolina all use assessments to determine families needs to help connect them with appropriate resources. Seven states found ways to give families a break from stressful lives. Some states provide a mix of supervised social and recreational activities for children while others provide more intensive services such as child care in the family s home or specialized care over night or during a weekend. In Alabama, 240 children attended an annual camp that gives parents a week to themselves while allowing children to spend time with peers. Six of the states provide training to therapists or other professionals about the needs of families who have adopted. The training can help make counseling services more beneficial. Oregon provides scholarships for mental health providers to take courses on these topics at Portland State University. North Carolina uses a federal grant to provide training and support to mental health professionals on trauma-based therapy. Adoption Services :: Audit results 17

18 Recommendations Our survey of parents who adopted children from foster care showed most do not need additional post-adoption services. However, some families cannot get all the services they require, especially for the children with the greatest needs. Many parents also had problems finding information about services in their communities. Twelve percent of the parents we surveyed negotiated their adoption support benefits in the past year. Of those parents, more than half gave poor to fair ratings regarding the negotiations. This is due in part to a lack of best practice guidelines for the program. The program is currently developing uniform guidelines to improve consistency. We reviewed eight states that provide additional services for adoptive families and we provide information on their efforts to help Washington determine how to better meet the needs of families adopting from foster care. We recommend the Department of Social and Health Services: 1. Develop a plan for enhancing post-adoption services for families adopting foster children using the parent survey results and information from other states. The plan should include strategies for addressing the largest service gaps identified in our report, including: Services for children whose disabilities significantly affect their lives Information on available services Submit the plan and associated resource needs to the Governor and the Legislature for consideration by January 1, Reach out to parents one year after DSHS finishes centralizing the program to determine whether their satisfaction with the unit s performance and its consistency has improved and report the results of its analysis to the Governor and the Legislature after the outreach is completed. Adoption Services :: Recommendations 18

19 Agency response STATE OF WASHINGTON February 4, 2014 The Honorable Troy Kelley Washington State Auditor P.O. Box Olympia, WA Dear Auditor Kelley: Thank you for the opportunity to respond to the State Auditor s Office (SAO) performance audit report on The Experiences and Perspectives of Washington Families Who Adopted Children from Foster Care. The Department of Social and Health Services and the Office of Financial Management have reviewed the report, and we hereby enclose our joint response and action plan. We agree that we can improve post-adoption services for Washington families. The Children s Administration has begun to review parent survey responses and other recommendations to help improve access to information and community resources for adoptive families and increase customer satisfaction. We appreciate that the SAO worked collaboratively with our staff during this audit and thank the audit team for its work. Sincerely, Kevin W. Quigley, Secretary Department of Social and Health Services David Schumacher, Director Office of Financial Management Enclosure cc: Joby Shimomura, Chief of Staff, Office of the Governor Kelly Wicker, Deputy Chief of Staff, Office of the Governor Ted Sturdevant, Executive Director for Legislative Affairs, Office of the Governor Wendy Korthuis-Smith, Director, Results Washington, Office of the Governor Tammy Firkins, Performance Audit Liaison, Results Washington, Office of the Governor Jennifer Strus, Assistant Secretary, Children s Administration Tracy Guerin, Deputy Director, Office of Financial Management Adoption Services :: Agency response 19

20 OFFICIAL STATE CABINET AGENCY RESPONSE TO THE PERFORMANCE AUDIT ON THE EXPERIENCES AND PERSPECTIVES OF WASHINGTON FAMILIES WHO ADOPTED CHILDREN FROM FOSTER CARE FEBRUARY 4, 2014 This coordinated management response to the draft audit report received on December 12, 2013, is provided by the Department of Social and Health Services (DSHS) and the Office of Financial Management. RECOMMENDATION 1: Develop a plan for enhancing post adoption services for families adopting foster children using the parent survey results and information from other states: a. The plan should include strategies for addressing the largest service gaps identified, including: o Services for children whose disabilities significantly affect their lives o Information on available services b. Submit the plan and associated resource needs to the Governor and the Legislature for consideration by January 1, RESPONSE We agree that post-adoption resources for families adopting foster children can help improve the overall adoption experience. The Children s Administration (CA) in DSHS has initiated work with the National Resource Center for Adoption to create a more informative post-adoption website. The website will help guide adoptive families to resources and services available in their community for the special needs of children adopted from foster care. The department will develop a list of experienced and knowledgeable counseling providers and furnish the list to adoptive families. Currently, the majority of post-adoptive support groups operate independently. CA is working to build a comprehensive post-adoptive network that will encompass both CA and community groups. Action Steps & Timelines Redesign the CA adoption website to separate pre- and post-adoption categories. Work has begun with the National Resource Center for Adoption to identify design needs to be included in the DSHS website redesign. By December 31, 2015 CA will work with stakeholders and nonprofit organizations to develop a public-private partnership to enhance resources for post-adoption services. Ongoing Page 1 of 2 Adoption Services :: Agency response 20

21 RECOMMENDATION 2: Reach out to parents one year after the DSHS finishes centralizing the adoption support program to determine whether their satisfaction with the unit s performance and its consistency has improved and report the results of its analysis to the Governor and the Legislature after the outreach is completed. RESPONSE We agree the department can improve overall customer service satisfaction. CA has begun work in this area by centralizing the adoption support program. Staff centralization to ensure consistent processes and information statewide CA has centralized the adoption support program and is finalizing processes and procedures. All adoption support consultants will have the same job description, expectations and responsibilities. Changes will assist in the consistency of information that adoptive families receive regardless of their location in the state at the time of adoption. Action Steps & Timelines Establish initial standard processes and procedures for reviewing adoption support case files to meet necessary case requirements in a timely manner. By January 31, 2015 CA will conduct a follow-up survey to adoptive families to assess for improved customer service satisfaction. By January 31, 2016 o The department is expanding the Continuous Quality Improvement (CQI) process. As a part of systems improvement, CA will do a survey once per year. Page 2 of 2 Adoption Services :: Agency response 21

22 Appendix A: Initiative 900 Initiative 900, approved by Washington voters in 2005 and enacted into state law in 2006, authorized the State Auditor s Office to conduct independent, comprehensive performance audits of state and local governments. Specifically, the law directs the Auditor s Office to review and analyze the economy, efficiency, and effectiveness of the policies, management, fiscal affairs, and operations of state and local governments, agencies, programs, and accounts. Performance audits are to be conducted according to U.S. General Accountability Office government auditing standards. In addition, the law identifies nine elements that are to be considered within the scope of each performance audit. The State Auditor s Office evaluates the relevance of all nine elements to each audit. The table below indicates which elements are addressed in the audit. Specific issues are discussed in the Results and Recommendations section of this report. I-900 element Addressed in the audit 1. Identification of cost savings No. The audit identified gaps in services for adoptive parents and did not identify cost savings. 2. Identification of services that can be reduced or eliminated 3. Identification of programs or services that can be transferred to the private sector 4. Analysis of gaps or overlaps in programs or services and recommendations to correct gaps or overlaps 5. Feasibility of pooling information technology systems within the department 6. Analysis of the roles and functions of the department, and recommendations to change or eliminate departmental roles or functions 7. Recommendations for statutory or regulatory changes that may be necessary for the department to properly carry out its functions 8. Analysis of departmental performance, data performance measures, and self-assessment systems No. The audit did not address services that could be reduced or eliminated. No. The audit did not assess whether the Adoption Support program could be transferred to the private sector. Yes. The audit identified gaps in services for adoptive parents and recommends that the department develop a plan to address the most critical gaps. No. The audit did not address the pooling of information systems within the Department as it was not relevant to our audit objectives. Yes. The audit assessed how the program s roles and functions affected the delivery of its services. No. The audit report does not contain recommendations for statutory or regulatory changes. No. The audit scope did not include analysis of performance measures or data. 9. Identification of best practices Yes. The audit includes examples of leading practices for providing post-adoption services. Adoption Services :: Appendix A 22

23 Appendix B: Scope and methodology We designed this performance audit to answer these three questions: 1. To what extent are the service needs of families who adopted from Washington s foster care system being met? 2. What are parents experiences working with Department of Social and Health Services Children s Administration to negotiate their benefits? 3. What can we learn from other states programs that can help improve services for families in Washington? We used three different approaches to address the audit objectives: a review of national research, case studies of other states, and a survey of parents who have adopted from Washington state foster care. National research review We reviewed numerous reports and studies that are made available through the Child Welfare Information Gateway, Casey Family Programs, and the National Resource Center for Adoption. We evaluated the credibility of these reports and studies by: Noting the affiliations of the researchers Evaluating the length of time the researchers have been working in the field of child welfare and the number of times they have published their work Noting if the studies had been published by scientific journals, universities, and / or governmental agencies Noting the intended audience of the publication Evaluating the timeliness of the studies We used the reports and studies to identify the benefits of post-adoption services and to inform which services to ask families about in the survey. Survey of adoptive parents in Washington Survey population and sampling method We surveyed a sample of families living in Washington that received adoption support benefits during fiscal year 2012 to find out more about their service needs and experiences working with the Adoption Support program. We used the Department of Social and Health Services Social Services Payment System data to identify families receiving benefits during the year. It was not cost-beneficial to survey all of the families receiving benefits. We surveyed a statistical random sample of 1,686 families. Assuming a 33 percent response rate for the survey, we chose a sample size to provide a precision of +/- 5 percent with 95 percent assurance. To ensure their adequate representation, we over sampled two groups of families families that recently adopted and families that received adoption support benefits for counseling. Though only a small percentage of total families, we wanted to ask key survey questions about their specific experiences. For analyses representing the experiences of all families, survey responses were weighted to compensate for the over-sampling. Survey development To develop the survey, first we reviewed similar surveys conducted in other states. Then we met with management at the Children s Administration to hear their perspective on questions they thought would be important to help them improve the program. We also interviewed other experts and stakeholders to get their input on the types of questions we should include. Considering the input we received, we developed a draft of the survey. We then worked with the Social and Economic Sciences Research Center at Washington State University to help us revise the survey instrument. We shared this draft with the Children's Administration and incorporated their feedback. We also pre-tested the survey with eight parents who have adopted from foster care in the state to ensure that our questions were clear and that we did not unintentionally omit something important to families. Adoption Services :: Appendix B 23